76
|
Palma JH, Almeida DR, Carvalho AC, Andrade JC, Buffolo E. Surgical treatment of acute type B aortic dissection using an endoprosthesis (elephant trunk). Ann Thorac Surg 1997; 63:1081-4. [PMID: 9124909 DOI: 10.1016/s0003-4975(97)00052-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The surgical treatment of acute complicated type B aortic dissection continues to be a challenge and is still associated with high morbidity and mortality rates. METHODS Seventy consecutive patients with an acute type B aortic dissection underwent an elephant trunk procedure through a median sternotomy during deep hypothermic circulatory arrest. An endoprosthesis that was 22 to 24 mm in diameter was inserted through an incision in the arch and held in place with only proximal sutures. RESULTS The mean arrest time was 31.4 +/- 8.7 minutes, and it was possible to adequately position the endoluminal graft in every patient. The procedure was done in association with other procedures in 13 patients. There were six in-hospital deaths not related to the endoprosthesis, and four late deaths. Late reoperation was necessary in 6 patients to manage leakage at the proximal suture line. CONCLUSIONS The insertion of an endoprosthesis through the arch for the management of a complicated acute type B dissection has several advantages over the conventional thoracotomy approach. The hospital mortality rate in this series of 70 patients was 20%, and the actuarial 5-year survival rate was 62.5%. We consider the elephant trunk procedure the treatment of choice in patients with type B acute dissections, regardless of whether the dissection is complicated or not.
Collapse
|
77
|
Gomes WJ, Carvalho AC, Vieira Filho JP, Souza RB, Palma JH, Maluf MA, Branco JN, Buffolo E. [Heart surgery in Brazilian Indians]. Arq Bras Cardiol 1997; 68:27-30. [PMID: 9334456 DOI: pmid/9334456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Our experience with surgical treatment of heart diseases in Indians living in the Amazon rain forest in primitive stages was reviewed. METHODS From 1988 to 1995, 18 patients underwent cardiovascular surgical procedures at the São Paulo Hospital of the Escola Paulista de Medicina. Seven patients had valvar disease, nine congenital heart defects, one submitral aneurysm and one arrhythmia. Thirteen Indians came from tribes of the Amazon rain forest area: three from the Xavante, two from Waiapi, two from Tucano, two from Macuxi, two from Mayoruna, and one of each tribe of Xikrin, Guajajara, Terena, Surui, Galibi, Cinta-Larga and Pataxó. RESULTS We performed 22 operations, with two hospital deaths. Follow-up was possible in 87.5% of cases, with one late death. The majority of cases were due to congenital heart defects and in this series it was noted the absence of operations to treat coronary artery disease. The incidence of valve disease was higher in accultured or semi-accultured Indians. CONCLUSION The surgical treatment of cardiovascular disease has made possible to the surviving indians to return to and be accepted by their fellow tribesmen.
Collapse
|
78
|
Nóbrega AC, Carvalho AC, Bastos BG. Resting and reflex heart rate responses during cholinergic stimulation with pyridostigmine in humans. Braz J Med Biol Res 1996; 29:1461-5. [PMID: 9196546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Dysfunction of the autonomic nervous system is of prognostic value for sudden death after acute myocardial infarction. Although the use of beta-blockers to counteract the adrenergic hyperactivity has been shown to decrease mortality in these patients, there have been no reports on the role of cholinomimetic drugs in the prognosis of patients after myocardial infarction. The present study was designed to investigate the effect of the administration of pyridostigmine bromide, a reversible anti-cholinesterase agent, on cardiac cholinergic activity assessed by the resting and reflex heart rate responses. Eight healthy volunteers were submitted to a conventional 12-lead electrocardiogram to obtain resting heart rate, and to three non-invasive cardiovascular tests: respiratory sinus arrhythmia, Valsalva maneuver and 4-sec exercise test. On two different days and following a randomized cross-over double-blind protocol, the experiments were performed before and 120 min after oral administration of either pyridostigmine bromide (30 mg) or placebo. Pyridostigmine increase (P < 0.05) the duration of the R-R intervals at rest (pre: 898 +/- 30 msec; post: 1019 +/- 45 msec; pre-placebo: 916 +/- 26 msec; post: 956 +/- 28 msec; P > 0.05). Although the duration of the R-R intervals during the autonomic tests was also increased (P < 0.05), the derived indexes of maximal fluctuation during the maneuvers did not change. These results indicate that oral pyridostigmine produces tonic cardiac cholinergic stimulation while exerting no effect on its reflex changes. Further studies are needed to address the potential role of the administration of pyridostigmine in the prognosis of patients with acute myocardial infarction.
Collapse
|
79
|
Almeida DR, Carvalho AC, Branco JN, Pereira AP, Correa L, Vianna PV, Buffolo E, Martinez EE. Chagas' disease reactivation after heart transplantation: efficacy of allopurinol treatment. J Heart Lung Transplant 1996; 15:988-92. [PMID: 8913915 DOI: pmid/8913915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chagas' disease is a parasitic infection that provokes a severe form of dilated cardiomyopathy. In the initial experience with heart transplantation with Chagas' disease, a high rate of acute reactivation has been reported. Although benzinidazole and nifurtimox are effective in the treatment of reactivation or of the acute phase of the disease they are associated with important adverse effects. Allopurinol has substantial activity against Trypanosoma cruzi in vitro, in the experimental laboratory and in chronic human Chagas' disease; however, there is no information regarding its action in Chagas' reactivation after heart transplantation. METHODS AND RESULTS We describe two patients with Chagas' disease who underwent heart transplantation. The first one had asthenia, anorexia, and several painful subcutaneous nodules in the legs after transplantation; biopsy showed an inflammatory infiltrate with intracytoplasmatic nests of Trypanosoma cruzi, confirmed by immunohistochemical stains with monoclonal antibodies specific to parasitic antigens. Allopurinol (600 mg/day) produced complete regression of the symptoms and the nodules with a negative control biopsy within 2 weeks. Treatment was maintained for 2 months. Mild leukopenia developed which improved after azathioprine reduction, and no further side-effects were noted. The second patient had sudden heart failure months after transplantation; endomyocardial biopsy showed myocardial fibers infested with Trypanosoma, and a concomitantly performed right heart catheterization showed a low cardiac index and highfilling pressures. The patient received allopurinol at a daily dose of 900 mg and conventional treatment for heart failure. Echocardiogram showed improved wall motion and decreased left ventricular dimensions, and control biopsy showed no inflammatory activity; cardiac index and filling pressures normalized. Treatment was maintained for 2 months without side effects. The two patients have not had recurrences and were in New York Heart Association functional class I 12 and 3 months, respectively, after discontinuation of allopurinol. CONCLUSIONS Allopurinol seems to be safe and effective in treating Chagas' disease reactivation after heart transplantation. A larger number of case studies seems to be necessary to properly evaluate its role in the treatment of Chagas' disease reactivation.
Collapse
|
80
|
Carvalho AC, Botelho LM, Greene LJ, Santos RA. Effect of acute volume expansion associated with salt load on the profile of plasma angiotensins in rats. IMMUNOPHARMACOLOGY 1996; 33:143-5. [PMID: 8856135 DOI: 10.1016/0162-3109(96)00030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We measured the changes produced in renin and the peptide components of the circulating renin-angiotensin system by acute volume expansion alone or associated with salt load in rats. With both maneuvers, there was a decrease of plasma renin activity (PRA) and plasma angiotensin (Ang) concentrations, but the changes were more pronounced in the salt-load group. In contrasting to Ang I and Ang II, plasma Ang-(1-7) concentration decreased significantly only within 60 min of 5.0% NaCl infusion (19.5 +/- 2.9 vs 30.5 +/- 1.9 pg/ml in the control group). As expected, plasma vasopressin increased markedly in the animals submitted to acute salt load (144.0 +/- 42.0 vs 5.0 +/- 0.2 pg/ml in the control group). The dissociation between the changes in plasma Ang-(1-7) and that of other plasma angiotensins is consistent with our previous studies using chronic salt load, and suggests that during acute volume expansion associated with salt load Ang I is preferentially converted to Ang-(1-7). In contrast to vasopressin, however, plasma Ang-(1-7) concentration increased only after chronic salt load, suggesting that this angiotensin may be more involved with long-term mechanisms of control of hydromineral balance.
Collapse
|
81
|
Almeida DR, Carvalho AC, Branco JN, Buffolo E, Martinez Filho E. [Pregnancy after heart transplantation]. Arq Bras Cardiol 1995; 65:237-42. [PMID: 8579511 DOI: pmid/8579511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A 25-year old female patient, with peripartum cardiomyopathy was submitted to heart transplantation and became pregnant two years after. Pregnancy was uneventful and a baby-girl was born completely healthy. Six years after pregnancy, the mother remains well with preserved ventricular function and the girl has had a normal development. Although considered a high-risk situation and not indicated, pregnancy after heart transplantation is possible, without any apparent deterioration of the transplanted graft and with healthy babies being delivered.
Collapse
|
82
|
Malheiros SM, Brucki SM, Gabbai AA, Bertolucci PH, Juliano Y, Carvalho AC, Buffolo E. Neurological outcome in coronary artery surgery with and without cardiopulmonary bypass. Acta Neurol Scand 1995; 92:256-60. [PMID: 7484082 DOI: 10.1111/j.1600-0404.1995.tb01698.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The neurological complications of coronary artery surgery with cardiopulmonary bypass (CPB) have been extensively studied, but to our knowledge those without CPB (NCPB) have not been defined. PATIENTS & METHODS We prospectively examined 81 patients, before and up to seven days after surgery, to compare the neurological morbidity between patients subjected to coronary artery bypass graft (CABG) surgery with and without CPB. We analyzed demographic variables, risk factors and neurological examination including neuropsychological (NPS) tests using chi-square and non-parametric analysis (Mann-Whitney and Kruskal-Wallis). RESULTS Forty-eight patients (34M; median age = 62 yrs; median number of grafts = 3 and median total surgery duration = 300 min) operated with CPB and 33 without CPB (23M; median age = 64 yrs; median number of grafts = 2 and median total surgery duration = 240 min) differed only in relation to number of grafts (p = 0.0001) and surgery duration (p = 0.0001). CONCLUSION We found no difference in early neurological outcome in patients subjected to CABG with or without CPB.
Collapse
|
83
|
Cantarelli MJ, Carvalho AC, de Almeida DR, Azevedo JE, Smith AC, Campos Filho O, Martinez Filho EE. [Acute hemodynamic effects of ibopamine, captopril, and placebo in patients with severe heart failure]. Arq Bras Cardiol 1995; 64:335-9. [PMID: 7495392 DOI: pmid/7495392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the acute hemodynamic effects of ibopamine (IBO), captopril (CAP) and placebo (PLA) in patients with severe congestive heart failure at rest. METHODS Twelve male patients in sinus rhythm with dilated cardiomyopathy and NYHA class IV were studied with Swan-Ganz hemodynamics. Drugs were given in a blinded fashion. Rest, 30 min and every hour for 5 h measurements were made after oral ingestion of 100 mg IBO, 25 mg CAP or PLA. Prior to the study, patients were on diuretics as the only medication for at least 48 h. Comparisons were made with analysis of variance of repeated measurements and Duncan's multiple comparisons procedure. RESULTS Significant increase in cardiac index and stroke volume index and reduction in systemic vascular resistance were observed with IBO and CAP for 2 h after ingestion. IBO however increased right and left filling pressures in the first hour after its administration. Ventricular tachycardia occurred in 2 patients 1 h after IBO administration. CONCLUSION Both IBO and CAP improved hemodynamic parameters in the first two hours after oral ingestion in patients with dilated cardiomyopathy in class IV.
Collapse
|
84
|
Buffolo E, Palma JH, Gomes WJ, Vega H, Born D, Moron AF, Carvalho AC. Successful use of deep hypothermic circulatory arrest in pregnancy. Ann Thorac Surg 1994; 58:1532-4. [PMID: 7979691 DOI: 10.1016/0003-4975(94)91952-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A woman pregnant for 21 weeks underwent an emergency operation because of an aortic arch aneurysm that had ruptured into her left lung. Cardiopulmonary bypass and deep hypothermia were used and she needed 37 minutes of circulatory arrest at a core temperature of 19 degrees C. Both the mother and fetus survived, and a normal baby was delivered by cesarean section at the 39th week of gestation.
Collapse
|
85
|
Carvalho AC, Romero I, Iazetti AV, Silva CC, Maluf M, Bocanegra J. [Supravalvar aortic stenosis complicated by aortic endarteritis and formation of mycotic aneurysm]. Arq Bras Cardiol 1994; 63:385-7. [PMID: 7611916 DOI: pmid/7611916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A 11 years-old male child, with supravalvar aortic stenosis who had as complications aortic endarteritis and mycotic aneurysm formation in the ascending aorta. The aneurysms were diagnosed by a control echocardiogram at the end of an apparently successful clinical treatment of endocarditis. Angiography confirmed the diagnosis and the aneurysms were surgically resected. Six months after surgery the patient is doing well.
Collapse
|
86
|
Gomes WJ, Carvalho AC, Palma JH, Gonçalves Júnior I, Buffolo E. Vasoplegic syndrome: a new dilemma. Rev Assoc Med Bras (1992) 1994; 40:304. [PMID: 7633508 DOI: pmid/7633508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
|
87
|
Werneck-Barroso E, Kritski AL, Vieira MA, Carvalho CE, Carvalho AC, Ferraz CM, Ferreira JA. Tuberculosis as a cause of false-positive results in HIV screening EIA tests. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1994; 75:394-5. [PMID: 7841435 DOI: 10.1016/0962-8479(94)90089-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
88
|
Carvalho AC, Takimura C, Gonçalves R, Silva CM, Tebexreni AS, Martinez Filho EE. [Emergency valvuloplasty with a balloon catheter of a tricuspid bioprosthesis in Ebstein's anomaly]. Arq Bras Cardiol 1994; 63:293-5. [PMID: 7771946 DOI: pmid/7771946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A case of severe stenosis of a tricuspid bioprosthesis was successfully dilated in a 13 year old young male with Ebstein's anomaly. The patient had congestive heart failure and developed cardiogenic shock; angiography revealed absence of emptying of the right atrium. Multiple size balloons (#4 to 23) were sequentially introduced with successful bioprosthesis dilation and shock resolution. Tricuspid bioprosthesis can be dilated even in critical conditions and, although a palliative procedure, balloon valvuloplasty can be a lifesaving procedure in patients with cardiogenic shock.
Collapse
|
89
|
Carvalho AC, Almeida DR, Campos Filho O, Gianotti I, Novo NF, de Souza JA, Alves CR, Azevedo JE, Moura LA, Palma H. [Comparative study of transthoracic Doppler echocardiogram, computed tomography and aortography in the diagnosis of thoracic aortic dissection]. Arq Bras Cardiol 1994; 63:179-84. [PMID: 7778988 DOI: pmid/7778988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Comparative and prospective evaluation of three methods (transthoracic echo-Doppler (TTE), computerized tomography (CT) and aortography (AORT) utilized for aortic dissection diagnosis. METHODS The 39 patients with confirmed aortic dissection (surgery or autopsy) underwent, within a few hours of each other, all three methods scrutinized. There were 19 cases of type A and 20 of type B dissection. RESULTS In type A dissection the methods were equivalent (TTE = 73.7%, CT = 84.2%, AORT = 73.7% p = NS) but for type B, TTE was significantly inferior to the other two methods (TTE = 60%, TC 90%, AORT = 80%, p < 0.05 for TTE, for TC and AORT p = NS). In three occasions, even though all three methods were performed, the diagnosis was not obtained. CONCLUSION The methods which were evaluated make the diagnosis in the majority of cases. In type A all methods are similar, however, in type B, TC and AORT are superior to TTE. Even performing all three methods in each patient, in three instances the diagnosis was not made.
Collapse
|
90
|
Carvalho AC, Lima JF, Soares AC, Lopes SL, Silva CM, Bocanegra J. [A cerebrovascular stroke in a child with an anomalous origin of the left coronary artery]. Arq Bras Cardiol 1994; 63:117-9. [PMID: 7661707 DOI: pmid/7661707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A two-year-old male child presenting anomalous origin of the left coronary artery diagnosed by Doppler echocardiography and confirmed by angiography developed an ischemic stroke, which is a rare event in this situation. He [correction of She] had good recovery of the neurological deficit and his anomalous artery was successfully reimplanted.
Collapse
|
91
|
Carvalho AC, Signorini L, Castelli F, Parravicini M, Di Lorenzo S. Migration medicine. The challenge of tuberculosis. Chest 1994; 105:1911. [PMID: 8205918 DOI: 10.1378/chest.105.6.1911a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
92
|
|
93
|
Almeida DR, Carvalho AC, Azevedo JE, Martinez EE. [Difficulties in the differential diagnosis of cardiomyopathies]. Arq Bras Cardiol 1994; 62:131-7. [PMID: 7944989 DOI: pmid/7944989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
|
94
|
Carvalho AC, Echeverria NG, Gonçalves R, Telles CA, Andrade JC, Buffolo E. [Late development of congestive heart failure in interventricular communication caused by penetrating wound, with pulmonary hypertension resolution after surgical correction]. Arq Bras Cardiol 1994; 62:119-21. [PMID: 7944987 DOI: pmid/7944987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Male, 33 years-old, with onset of heart failure and edema; he used to be completely asymptomatic but mentioned he underwent previously a pleural drainage, after a hemothorax provoked by a stab wound. His physical examination confirmed he was in heart failure and showed a harsh holosystolic murmur between mitral and tricuspid areas. Cardiac catheterization demonstrated a large apical ventricular septal defect (VSD) and systemic pulmonary arterial pressures. With oxygen there was an increase in the left to right shunt and normal pulmonary vascular resistance. The clinical diagnosis was that of a traumatic VSD provoking pulmonary hypertension although a congenital etiology could not be completely ruled out. At surgery there was a sharp cut at the pericardium and an apical epicardial lesion; the VSD was patch sutured and the patient did well with control of his heart failure. A control hemodynamic study performed within the first postoperative month showed no residual shunt and complete normalization of the pulmonary pressures and resistance.
Collapse
|
95
|
Kritski AL, Werneck-Barroso E, Vieira MA, Carvalho AC, Carvalho CE, Bravo-de-Souza R, Andrade GDN, Galvao-Castro B, Castilho EA, Hearst N. HIV infection in 567 active pulmonary tuberculosis patients in Brazil. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES 1993; 6:1008-12. [PMID: 8340889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We studied 567 patients with active pulmonary tuberculosis (APT) in Rio de Janeiro, Brazil, by using a standardized questionnaire and by testing blood for HIV antibodies. The rate of HIV infection was 3.9% in 1987, 4.8% in 1988, and 5.2% in 1989, and did not differ by sex. It was highest (7.4%) in the 15- to 39-year age group. There was no difference between patients infected and not infected by HIV with regard to education, income, housing, or employment. Among all patients with definite HIV risk behavior, the HIV infection rate was 23.3%, rising to 31.2% among homo/bisexual men and 36.4% among intravenous drug users, and the rate was 6.5% for blood-transfusion recipients. Among patients who denied risk behavior, the rate was 1.2%. Generalized lymphadenopathy and oral candidiasis occurred with greater frequency among HIV-infected patients (p < 0.0001). Applying the World Health Organization 1985 clinical criteria and revised case definition for AIDS, we found, respectively, sensitivities of 34% and 76.9% and specificities of 31% and 26.3%; in the Rio de Janeiro environment, these clinical criteria without HIV serology should not be adopted for tuberculosis patients. For chest radiographs, a significant association was found between HIV infection and the occurrence of atypical images (p = 0.0001), and hilar and/or mediastinal adenopathy (p = 0.0002) and absence of cavities (p = 0.0003). A PPD (purified protein derivative) skin test induration of < 5 mm was identified in 53% of the HIV-positive cases and in 31.3% of the HIV-negative cases. Only 11.5% of HIV-infected APT patients met the Centers for Disease Control 1987 AIDS criteria.
Collapse
|
96
|
Almeida DR, Carvalho AC, Pessoa C, de Sousa JA, Branco JN, Silva LC, Moura L, Castelo HJ, Alves CM, Andrade JC. [Hemodynamic study with Swan-Ganz catheterization, concomitant to endomyocardial biopsy in heart transplantation patients. Importance in the early diagnosis of rejection]. Arq Bras Cardiol 1993; 61:171-4. [PMID: 8110047 DOI: pmid/8110047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the role of hemodynamic parameters in the diagnosis of acute rejection who underwent orthotopic cardiac transplantation. METHODS A protocol was carried out in 19 patients who underwent heart transplantation and in whom Swan-Ganz hemodynamics was performed immediately prior to routine endomyocardial biopsy in the first few months postoperatively. The results of 28 biopsies were divided in group I--severe rejection who needed pulse-therapy (n = 10) and group II--No or mild/moderate rejection who did not need any pulse (n = 18). Hemodynamic parameters were compared between both groups. RESULTS There were significant differences among hemodynamic parameters in groups I and II. Group I had higher mean right atrial pressures (13.0 x 7.3 mmHg), mean pulmonary pressure (26.3 x 20.4 mmHg), mean wedge pressure (14.4 x 10.9 mmHg) and lower cardiac index (2.57 x 3.10 l/min/m2). CONCLUSION In a routine situation, hemodynamic measurements, as obtained with Swan-Ganz catheter, simultaneously with endomyocardial biopsies, show significant alterations in transplanted patients who develop acute rejection. This information, obtained earlier than the biopsy results, could shorten the time to initiate pulse-therapy in patients with severe rejection.
Collapse
|
97
|
Campos O, Andrade JL, Bocanegra J, Ambrose JA, Carvalho AC, Harada K, Martinez EE. Physiologic multivalvular regurgitation during pregnancy: a longitudinal Doppler echocardiographic study. Int J Cardiol 1993; 40:265-72. [PMID: 8225661 DOI: 10.1016/0167-5273(93)90010-e] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Valvular function, assessed by Doppler technique, has not been extensively investigated during normal pregnancy. To prospectively study this feature, 18 normal pregnant women were followed during their pregnancies and puerperium, with serial clinical and pulsed-continuous Doppler echocardiographic examinations. In four gestational periods and the puerperium, we analysed: (a) ventricular and atrial dimensions, as well as valve annular diameters; (b) prevalence and characteristics of trivial valvular regurgitations. During pregnancy, slight but significant increases of the four cardiac chamber dimensions and valve annular diameters were observed, except for the aortic ring. The prevalence of physiologic valvular regurgitation in early pregnancy (mitral, 0%; tricuspid, 38.9%; pulmonary, 22.2%; aortic, 0%), was similar to a control group of 18 healthy non-pregnant women. As pregnancy evolved, there was a progressive and significant increase of multivalvular regurgitation, maximal at full-term (mitral, 27.8%; tricuspid, 94.4%; pulmonary, 94.4%, P < 0.05 vs. early pregnancy). Aortic regurgitation was not detected in any stage of pregnancy. In the puerperium, mitral regurgitation resolved, but tricuspid and pulmonary regurgitation were still significantly prevalent (83.3% and 66.7%, respectively, P < 0.05 vs. early pregnancy). It is concluded that physiologic multivalvular regurgitation is frequent in pregnancy, mainly involving right-sided valves in late gestational periods, occasionally persisting in the early puerperium. Chamber enlargement, valve annular dilatation, and increased prevalence of trivial valve regurgitation are time-related events during normal pregnancy, resulting from a reversible cardiac remodeling process induced by physiologic volume overload. These aspects should be considered for a correct interpretation of Doppler echocardiographic findings in pregnant women with suspected heart disease.
Collapse
|
98
|
Andrade JL, Leal SM, Campos Filho O, Carvalho AC, Tebexreni AS, Lima VC. Contrast echocardiography during cardiac catheterization in patients with congenital heart diseases. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1993; 29:117-21. [PMID: 8348595 DOI: 10.1002/ccd.1810290206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Contrast echocardiography performed during cardiac catheterization has mostly been limited to a few published case reports. We studied 37 patients with congenital heart disease to assess the capability of the method to diagnose cardiac shunts and valve regurgitation. Injections of 5% dextrose in water through an angiographic catheter were made to evaluate septal integrity and valve competence compared with conventional contrast angiography. An overall sensitivity of 93% and specificity of 78% were found. In four cases of atrial septal defect and seven of mitral regurgitation, the sensitivity was 100%. It was slightly lower for eleven cases of ventricular septal defect (91%) and four of patent ductus arteriosus (75%). When assessing aortic, tricuspid and pulmonary valve competence, the method proved to be more sensitive than conventional angiography to detect mild regurgitation. Contrast echocardiography is a sensitive and safe technique that may be used in association with conventional angiography reducing the need for radiographic contrast and ionizing radiation time.
Collapse
|
99
|
Gomes WJ, Palma JH, Aguiar LF, Garcia Júnior HV, Carvalho AC, Branco JN, Buffolo E. [An unusual indication of deep hypothermia with total circulatory arrest for myocardial revascularization surgery]. Arq Bras Cardiol 1993; 60:187-8. [PMID: 8250749 DOI: pmid/8250749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The authors relate a case of 69 years old patient with unstable angina and left main coronary artery disease, who underwent aggressive mediastinal radiotherapy for lymphoproliferative syndrome 20 years ago and who needed urgent myocardial revascularization. Due to great calcification and heavily heart adherences it was performed 20 degrees C deep hypothermic circulatory arrest to avoid aortic clamping and to make the anastomosis with better exposition of the aorta and coronary arteries.
Collapse
|
100
|
Campos Filho O, Andrade JL, Carvalho AC, Luna Filho B, Pfeferman A, Arroyo JB, Leão LE, Martínez Filho EE. [Assessment of pulmonary arterial pressure in adults with Doppler echocardiography]. Rev Port Cardiol 1993; 12:241-7. [PMID: 8512716 DOI: pmid/8512716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the role of pulsed Doppler echocardiography (PDE) in the indirect assessment of pulmonary artery (PA) pressure (P), analysing the pulmonary velocity blood flow curves (PVBFC) profile. PATIENTS AND METHODS Sixty-one adults with several kinds of heart disease were submitted to heart catheterization to obtain PAP (systolic, diastolic, mean), and other hemodynamic variables. A PDE examination was performed in all to obtain the PVBFC at the level of the pulmonic annulus. Qualitative features of the curve were analysed (morphological pattern, presence of pulmonic regurgitation) as well as quantitative data (acceleration time = AT, right ventricle ejection time = RVET index, AT/RVET index AT corrected for heart rate = ATC), which were compared to the invasive measurements. RESULTS An abnormal rapid acceleration of the PVBFC, with triangular configuration, was noted in patient with pulmonary hypertension (PH), in contrast to the dome-like shape of the PVBFC in normal PAP. Pulmonary regurgitation was more frequent (p < 0.05) in patients with severe PH (mean PAP > or = 40 mmHg), comparing with patients with PAP < 40 mmHg. Inverse linear correlations were observed between AT and mean PAP, particularly when sinus rhythm was present (r = 0.89; p < 0.05) excluding patients with atrial fibrillation (19 cases). CONCLUSION PDE is an useful and noninvasive method for indirect evaluation of PAP in adults, especially during stable sinus rhythm, in heart rate range from 60 to 115 bpm.
Collapse
|